Conditions & Treatments

Celiac Disease

Celiac disease is a digestive disease that damages the small intestine because of a sensitivity to gluten, which is found in wheat, rye, barley, and oats. This hereditary disorder interferes with the absorption of nutrients from food.

Celiac Disease

What is celiac disease?

Celiac disease is a digestive disease that damages the small intestine because of a sensitivity to gluten, which is found in wheat, rye, barley, and oats. This hereditary disorder interferes with the absorption of nutrients from food.

When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. Tiny fingerlike protrusions, called villi, which line the small intestine and enable the absorption of nutrients from food into the bloodstream, are lost. Without these villi, malnutrition occurs, regardless of how much food a person consumes.

Celiac disease is more common in people of European ancestry, Caucasians, and people with type 1 diabetes. More than 2 million Americans have been diagnosed with celiac disease; however, recent studies have suggested that as many as one in every 133 Americans may have it, and that the disease is underdiagnosed.

What causes celiac disease?

Celiac disease is a genetic disease that runs in families. A person can have the disease and not know it until it is triggered by severe stress, pregnancy, surgery, physical injury, infection, or childbirth.

What are the symptoms of celiac disease?

Celiac disease affects people in different ways. Some persons may develop symptoms as children, whereas others do not experience symptoms until adulthood. Some may have diarrhea and abdominal pains, while others have irritability or depression with the onset of the disease.

While the following are common symptoms of celiac disease, each individual may experience symptoms differently. Symptoms may include:

Chronic diarrhea or constipation

Weight loss

Recurring abdominal pain and bloating

Gas

Pale, foul-smelling stool

Unexplained anemia

Muscle cramps and/or bone pain

Pain in the joints

Tingling numbness in the legs

Delayed growth

Fatigue

Painful skin rash

Missed menstrual periods (which is linked to excessive weight loss)

Tooth discoloration or loss of enamel

Sometimes, people with celiac disease are asymptomatic, because the undamaged part of the small intestine is still able to absorb enough nutrients. However, these people are still at risk for complications of the disease.

The symptoms of celiac disease may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is celiac disease diagnosed?

Since symptoms of celiac disease are similar to those of other digestive diseases such as Crohn's disease, irritable bowel syndrome, ulcerative colitis, diverticulosis, and intestinal infections, it can be difficult to diagnose.

In addition to a complete medical history and physical examination, diagnostic procedures for celiac disease may include the following:

Blood work. (To measure the level of antibodies to gluten.) Researchers have found that persons with celiac disease have higher than normal levels of certain antibodies in their blood. These antibodies by the immune system in response to substances (such as gluten) that the body perceives as threatening.

Biopsy. To diagnose celiac disease, the doctor may remove a tiny piece of tissue from the small intestine to check for damage to the villi. During the procedure, the doctor eases a long, thin tube, called an endoscope, through the mouth and stomach into the small intestine. A sample of tissue is then taken using instruments passed through the endoscope. This procedure is considered the "gold standard" for diagnosis of celiac disease.

What is the treatment for celiac disease?

Specific treatment for celiac disease will be determined by your doctor based on:

Your age, overall health, and medical history

Extent of the disease

Your tolerance of specific medicines, procedures, or therapies

Expectations for the course of the disease

Your opinion or preference

A gluten-free diet is the only treatment for persons with celiac disease. Adhering to a gluten-free diet is a lifetime requirement, as eating any gluten will further damage the intestine.

For most people, eliminating gluten from their diet will stop symptoms, heal intestinal damage that has already occurred, and prevent further damage. Usually, a person will see an improvement in symptoms within days of starting the diet and, within three to six months, the small intestine is usually completely healed, with villi intact and working. For older persons, complete healing may take up to two years.

Treatment Programs

Massachusetts General Hospital understands that a variety of factors influence patients' health care decisions. That's just one reason why we're dedicated to ensuring patients understand their diagnosis and treatment options. Because a single option might not serve all patients, we offer a wide range of coordinated treatments and related services across the hospital. Patients should consult with their primary care doctor or other qualified health care provider for medical advice and diagnosis information.

Weight CenterThe Massachusetts General Hospital Weight Center is a fully integrated center within the Digestive Healthcare Center that supports the spectrum of needs for people of all ages seeking help with obesity and weight loss.

Crohn’s and Colitis Center The Massachusetts General Hospital Digestive Healthcare Center’s Crohn’s and Colitis Center is one of the few comprehensive, multidisciplinary programs in New England dedicated to the diagnosis and treatment of patients with Crohn’s disease and ulcerative colitis.

Pediatric ImagingThe Pediatric Imaging Program at Massachusetts General Hospital Imaging specializes in ensuring the safety and comfort of child patients while providing the latest technology and the expertise of specialized pediatric radiologists.

Midlife Women's Health CenterThe Massachusetts General Hospital Midlife Women’s Health Center brings together experts from more than 15 specialties to improve, promote and advance health care for women at menopause and beyond through research, collaboration and education.

Celiac Disease ProgramThe Celiac Disease Program at Massachusetts General Hospital brings together a multidisciplinary team of experts that collaborate with patients with celiac disease to co-create health.

Dr. Alessio Fasano, director of the Center for Celiac Research, speaks with Jules Shepard on The Gluten Free Voice Radio Show to discuss the Center’s future and the move to MassGeneral Hospital for Children.

After nearly two decades of providing clinical care for patients and conducting innovative research on celiac disease and other gluten-related disorders, the Center for Celiac Research has relocated from Baltimore to Massachusetts General Hospital for Children (MGHfC), as part of the MGHfC’s newly renamed Mucosal Immunology and Biology Research Center.

Transcending the disciplines of microbiology, molecular and cell biology, and physiology, Dr. Alessio Fasano’s research focuses on the mucosal biology of the gut. By focusing on the “cross talk” between enteric pathogens and their hosts, Dr. Fasano’s group has elucidated various organs and cell functions involved in health and disease, including inflammatory and autoimmune disorders.

Overuse of popular NSAIDs is associated with intestinal permeability, which is a condition associated with celiac disease and other autoimmune disorders. Dr. Alessio Fasano, director of the Center for Celiac Research at MassGeneral Hospital for Children, discusses the implications of using popular pain medication in relation to gluten-related disorders and exercise.

In this news segment with Dr. Mallika Marshall from WBZ-TV Boston, Dr. Alessio Fasano, joined by patient Sharone Jelden, talks about diagnosis and treatment for celiac disease and who benefits from following a gluten-free diet.

Maureen Leonard, MD, is looking for 500 newborns at risk for celiac disease. The third-year Mass General Hospital for Children (MGHfC) Pediatric Gastroenterology fellow is working with Alessio Fasano, MD, director of the Center for Celiac Research and division chief of Pediatric Gastroenterology and Nutrition at MGHfC.

The Center for Celiac Research and Treatment at MassGeneral Hospital for Children celebrated a milestone Aug. 5, when new Food and Drug Administration standards for gluten-free labeling went into effect.

This course is designed to meet one or more of the following Accreditation Council of Graduate Medical
Education competencies: Patient care; Medical knowledge; Practice-based learning and improvement; Interpersonal and communication skills; Professionalism; Systems-based practice